Treatment of childhood cancer has been one of the resounding successes of medicine in the last half of the 20th century, as 1 in 640 young adults in the US is a survivor of childhood cancer. With increased person-years of life impacted, cardiovascular (CV) disease is now the leading cause of non-cancer death in childhood cancer survivors. Anthracycline chemotherapy is a major risk for this CV morbidity and mortality. A lack of functional markers of CV risk has limited cardioprotection and secondary prevention strategies. Cardiac magnetic resonance imaging (CMR) provides precise measures of aortic and cardiac function, making it ideal for establishing surrogate markers of subclinical disease in smaller populations. Our project is an observational clinical trial with a cross-sectional and longitudinal design to evaluate the application of CMR in detecting subclinical markers of cardiac injury after anthracycline therapy. We plan to use CMR to measure aortic stiffness and myocardial wall strain in adolescent/young adult survivors of childhood cancer off therapy in comparison to a control group without cancer. In addition we will evaluate the ability of CMR to detect and follow changes in aortic function in newly diagnosed adolescent patients receiving anthracycline chemotherapy. The trial at two childhood cancer programs will lead to: novel CMR biomarkers of subclinical anthracycline cardiotoxicity~ an understanding of previously unexplored concepts of aortic stiffness and myocardial strain in the pathophysiology~ and the establishment of a young anthracycline exposed cohort who can be followed with CMR for future studies of the technology and targeted interventions. This Quick Trial of CMR will facilitat development of needed surrogate endpoints for timely, targeted pharmacologic or behavioral interventions to alleviate the burden of CV disease in this cancer population. PUBLIC HEALTH RELEVANCE: Currently 1 in 640 young adults in the U.S. is a childhood cancer survivor, with late effects of cancer therapy negatively impacting health for decades of life remaining. Cardiovascular disease is now the leading cause of non-cancer morbidity and mortality in this population. Cancer care now requires initiatives for early detection, cardio protection and secondary prevention of cardiac disease in this young population.